
<form action="acao/newsletter.php?acao=cadastrar" method="post">
  <p>Nome
    <br />
    <input name="nome" type="text" class="text-input medium-input datepicker" id="nome" />
    <br>
    </p>
  <p>E-mail<br />
    <input name="email" type="text" class="text-input medium-input datepicker" id="email" />
    <br />
</p>
  <p>Data <br />
    <input name="data" type="text" class="text-input small-input datepicker" id="data" value="<?=date("d/m/Y H:i:s")?>" />
    <br />
    </p>
  <p>Tipo de e-mail<br />
    <select name="tipo">
    <option value="1">Cadastrado</option>
    <option value="0">Visitantes</option>
    </select>
    
<br />
    <br />
Ativo:
<input name="ativo" type="checkbox" id="ativo" value="1" />
<br />
<br>
<input type="submit" class="button" value="Cadastrar">
  </p>
</form>
